Стан фетоплацентарного комплексу у вагітних після міомектомії

Abstract

Одесское отделение Ассоциации акушеров-гинекологов Украины, Одесса, Украина Получены результаты анализа клинического хода беременности и гормональных исследований у беременных с рубцом на матке после миомэктомии, показано наличие тенденции к определенной взаимосвязи между локализацией плаценты, улучшением состояния фетоплацентарного комплекса (по результатам гормональных исследований) и особенностями клинического хода гестации в зависимости от способа проведения операции, что дает возможность прогнозировать клинический ход беременности у этих женщин.

Background: The most common benign tumor of the female genital organs is myoma. Each fifth woman at the reproductive age is diagnosed with this pathology [1–4]. The significantly less research is devoted to the study of the functional state of fetoplacental complex after surgery in different methods with the complexity of the estimation connected with the existing of pre-pregnancy neurohumoral changes featured to the tumor and the anatomic and functional changes in the myometrium, formed after surgery [8–10] Material and Methods: The course of pregnancy for 126 women who had pre-pregnancy conservative myomectomy, who were divided into two groups depending on the method of operation has been studying. 1st group — 59 pregnant women after conservative myomectomy under the existing methods; 2nd group — 67 pregnant women after conservative myomectomy with the developed technique of the operation (“Method for performing myomectomy during cesarean section” patent O. O. Zelinsky, O. V. Zhovtenko) The main groups formed two sub-groups: 1A — 10 women and 2A — 12 women (pregnant women, whose feto-placental condition was analyzed with placental localization in myomectomy zone). The control group consisted of 30 pregnant women without somatic and genital pathology, who were primapara. Results of the research. 1. It was found that major part of patients surveyed possessed different concentrations of β-hCG, E2 and progesterone, levels of these hormones were significantly lower for women from group 1 compared to the ones from group 2, especially for pregnant women with threatened abortion. 2. The pregnant from 1 and 2 groups with high concentrations of serum TBG were determined for the women with symptomatic threat of the spontaneous abortion and partial detachment of the chorion. 3. Analysis of the blood serum of pregnant AMGF content from 7 to 12 weeks of gestation displayed a tendency to lower for women AMGF content from the groups 1 and 2 compared to the those from the control group of the pregnant women. 4. In assessing the concentration of PAMG-1 the tendency to increase of the protein levels in groups 1 and 2 compared to the ones from control group. It was determined the presence of IUGR for women with a uterine scar after myomectomy. Thus, the dependence between the threatened abortion and pre-term labour in patients with scar on the uterus after myomectomy from the one side and the reduction of the functional state for the chorion, due to violations of the implantation process in scar-altered uterus for the other side. The above trend was more appeared for the pregnant women with placenta localization in the area of the myomectomy. However, due to the small number of studies (group 1A — 10 women and in group 2A — 12 females) it was impossible to define the dependence.